右上肢喪失感を呈した1剖検例

CONSCIOUS HEMIASOMATOGNOSIA OF THE RIGHT UPPER EXTREMITY AN AUTOPSY CASE

I．はじめに

　半側性身体図式障害は自己の半身に関する心像が自己への所属感を失なつてしまう現象であるという^13）。かかる現象は特異的であり，かつ稀であるゆえに，研究者の関心を惹き，症状の分類，発生機序，障害部位などについて多くの検討がなされてきたが，その責任病巣については，現在なお議論のあるところである。本邦においても，井村ら^6），吉田^21），大橋^13），黒丸ら^8）によるすぐれた業績がある。しかし剖検例は数例にすぎず，またその多くは脳腫瘍例で，障害範囲の決定が必ずしも容易でないものである。

　ここに報告する症例は，右半身麻痺に伴なつて右上肢の喪失感を訴え，剖検の結果，左大脳半球の頭頂葉を中心とし，皮質にほぼ限局する軟化壊死巣を認めたものである。

A 66-year-old, right handed man had a cere-brovascular attack, followed by the right hemi-paresis and the feeling of "loss of his right arm".The latter complaint was lasted for about fortydays. Neurological examinations in the onset re-vealed that the patient was arouse and cooperative,and had conscious hemiasomatognosia of the rightupper extremity, Gerstmann's syndrome, autotopo-agnosia of his face, construtive apraxia and con-duction aphasia. Motor weakness was rather promi-nent in the right upper extremity, where thepostural sence was lost completely though otherperceptions were decreased. The patient had twoattacked about 6 months later, associating with deepcoma and left hemiplegia, and died of pneumoniaabout 8 months after the onset.

The autopsy revealed large brownish infractionsin the bilateral fronto-parietal lobes, being older inthe left hemisphere. The left lesion was wellcircumscribed in the cortices and subcortical whitematter, involving the pre- and post-central, supra-marginal and angular gyri and the superior perietallobule. The callosal body and brain stem includingthe thalamus were almost intact.

It seems likely that the conscious hemiasoma-tognosia of the present case was resulted from thelesion in the inferior and superior parietal lobulesof the left side and that the intensive disturbanceof the deep sense, also, played an important rolein the appearance of the conscious hemiasomatog-nosia.